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These days practitioners aim to carry all pregnancies to term, or 39 weeks — which means labor should not be induced electively before then. However situations do sometimes arise when nature needs a little nudge. If a pregnancy is postterm (that is, you’ve reached 42 weeks) or your health or your baby’s is at risk, your practitioner may determine it’s time to start labor contractions using medications or other methods. Here’s why your doctor might induce labor and what to expect if it happens to you.

Why labor is induced

There are a number of reasons your practitioner may decide to induce labor, including:

You're overdue. If there's no sign of action from your uterus, your practitioner may induce you around 42 weeks.

You might not make it to the hospital. You may be induced if you live far from where you’re delivering or have had a previous short labor because there’s concern that you might not make it to the hospital or birthing center on time. Known as an elective induction, it should be scheduled at the place where you plan to deliver no earlier than 39 weeks.

When you might get a C-section instead

There are some circumstances where labor shouldn’t be induced and a C-section is preferable, including:

The need (because of fetal distress, for instance) for immediate delivery

What happens if you are induced

If you do end up needing to be induced, the process involves a number of steps, though you usually won’t go through all of them:

Cervical ripening. Usually your cervix will open up naturally on its own once you’re ready to go into labor. However if your cervix shows no signs of dilating and effacing (softening, opening, thinning) to allow your baby to leave the uterus and enter the birth canal, your practitioner will need to get the ripening rolling. She’ll usually do this by applying a topical form of the hormone prostaglandin (either a gel or a vaginal suppository) to your cervix. Your cervix will be checked after a few hours; often, this will be enough to get labor and contractions started. However if the prostaglandin is doing its work ripening the cervix but contractions haven’t started, the process continues on to the following steps. [Note that sometimes if you’ve had a C-section or other previous uterine surgery, you won’t be given prostaglandin to try to prevent uterine rupture. And in some cases, your practitioner may use a mechanical agent to ripen the cervix (such as a catheter with an inflatable balloon or graduated dilators) instead.]

Membrane stripping. If your bag of waters (amniotic sac) is still intact, your practitioner may get labor started by swiping her finger across the fine membranes that connect the amniotic sac. This causes the uterus to release prostaglandin, just as it would if labor began naturally, which should in turn cause the cervix to soften and contractions to start. This process isn’t always pain-free, and while it isn’t meant to break your water it sometimes does.

Rupturing the membrane. If your cervix has already begun to dilate and efface on its own but your water hasn’t broken, your practitioner might jump-start your contractions by artificially rupturing the membranes. That is, she’ll break the bag of waters that surrounds your baby manually using an instrument that looks like a long crochet hook with a sharp tip. It might feel uncomfortable, but it shouldn’t be painful.

Pitocin. If neither the prostaglandin gels nor the stripping or rupturing of the membranes has brought on regular contractions within a couple of hours, your practitioner will slowly give you the medication Pitocin (a synthetic form of the naturally-occurring hormone oxytocin) via an IV to induce or augment contractions. When Picotin is used, contractions — which usually start about 30 minutes later — are usually stronger, more regular and more frequent than those where labor has begun naturally (though if this is your first baby, you won't have anything to compare it with). If you’re considering an epidural, you might want to ask your practitioner about getting it started while you’re receiving Picotin so it’s in place once labor does start.

The risks of labor induction

While in the majority of cases labor induction goes smoothly, complications sometimes arise. They include:

However know that throughout the process your baby will be continuously monitored via electronic fetal monitoring, which will help your practitioner to assess how he or she is dealing with the stress of induced labor and take steps to protect both of you.

What happens next

Occasionally labor induction doesn’t work, especially for first-time mothers and those whose cervix isn’t effaced and dilated. If this is the case for you, your practitioner may try to induce labor again or opt for a C-section.

Once your contractions are in full swing, your labor should progress just as a non-induced labor does (learn more about the phases of labor).

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